Organization
INTEGRATIVE NEUROLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM GRIMES D.O. (PRESIDENT)
(940) 626-1870
Entity
Organization
Contact information
Practice address
2000 S FM 51, SUITE A, DECATUR, TX 76234-3702
(940) 626-1870
(940) 626-1871
Mailing address
2000 S FM 51, SUITE A, DECATUR, TX 76234-3702
(940) 626-1870
(940) 626-1871
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
F5926
TX
2084N0600X
Clinical Neurophysiology Physician
F5926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020NP
BCBS
TX
01
—
DE4924
MEDICARE RR
TX
05
—
PENDING
—
TX
Enumeration date
02/09/2007
Last updated
09/29/2010
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